Pathophysiology of delirium in the intensive care unit

被引:139
作者
Gunther, Max L. [1 ,2 ,3 ]
Morandi, Alessandro [1 ,4 ,5 ]
Ely, E. Wesley [1 ,2 ]
机构
[1] Vanderbilt Univ Sch Med, Ctr Hlth Serv Res, Nashville, TN 37232 USA
[2] VA Tennessee Valley Geriatr Res Educ & Clin Ctr, Nashville, TN 37212 USA
[3] Univ Georgia, Dept Psychol, Athens, GA 30602 USA
[4] Poliambulanza Hosp, Dept Internal Med & Geriatr, I-25100 Brescia, Italy
[5] Geriatr Res Grp, I-25122 Brescia, Italy
关键词
D O I
10.1016/j.ccc.2007.10.002
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Delirium, or acute brain dysfunction, is a life-threatening global disturbance in cognitive functioning that frequently manifests in critically ill patients. This review examines the current status of knowledge regarding the pathophysiology of delirium in the ICU, in particular, evaluating the role of iatrogenic factors such as sedatives and analgesic administration in brain dysfunction. This hypothesis is considered along with several other plausible mechanisms of ICU delirium, including sepsis, postoperative cognitive dysfunction, and changes in biomarkers and neuro-transmitters. The review concludes by highlighting potential future directions in molecular genetics for the elucidation of delirium and its long-term consequences.
引用
收藏
页码:45 / +
页数:22
相关论文
共 175 条
[81]   Six-month neuropsychological outcome of medical intensive care unit patients [J].
Jackson, JC ;
Hart, RP ;
Gordon, SM ;
Shintani, A ;
Truman, B ;
May, L ;
Ely, EW .
CRITICAL CARE MEDICINE, 2003, 31 (04) :1226-1234
[82]   BLOOD-BRAIN-BARRIER DERANGEMENT IN SEPSIS - CAUSE OF SEPTIC ENCEPHALOPATHY [J].
JEPPSSON, B ;
FREUND, HR ;
GIMMON, Z ;
JAMES, JH ;
VONMEYENFELDT, MF ;
FISCHER, JE .
AMERICAN JOURNAL OF SURGERY, 1981, 141 (01) :136-142
[83]  
JONES RS, 2004, AGS, V52, pS57
[84]   Is anaemia a risk factor for delirium in an acute geriatric population? [J].
Joosten, Etienne ;
Lemiengre, Joke ;
Nelis, Tine ;
Verbeke, Geert ;
Milisen, Koen .
GERONTOLOGY, 2006, 52 (06) :382-385
[85]   Risk factors and prediction of postoperative delirium in elderly hip-surgery patients: Implementation and validation of a medical risk factor model [J].
Kalisvaart, Kees J. ;
Vreeswijk, Ralpb ;
de Jonghe, Jos F. M. ;
van der Ploeg, Tjeerd ;
van Gool, Willem A. ;
Eikelenboom, Piet .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2006, 54 (05) :817-822
[86]   DELIRIUM IN CRITICAL CARE UNIT PATIENTS ADMITTED THROUGH AN EMERGENCY ROOM [J].
KISHI, Y ;
IWASAKI, Y ;
TAKEZAWA, K ;
KUROSAWA, H ;
ENDO, S .
GENERAL HOSPITAL PSYCHIATRY, 1995, 17 (05) :371-379
[87]   Neuropsychiatric background of alcohol hallucinosis: A SPECT study [J].
Kitabayashi, Yurinosuke ;
Narumoto, Jin ;
Shibata, Keisuke ;
Ueda, Hideki ;
Fukui, Kenji .
JOURNAL OF NEUROPSYCHIATRY AND CLINICAL NEUROSCIENCES, 2007, 19 (01) :85-85
[88]   The use of continuous IV sedation is associated with prolongation of mechanical ventilation [J].
Kollef, MH ;
Levy, NT ;
Ahrens, TS ;
Schaiff, R ;
Prentice, D ;
Sherman, G .
CHEST, 1998, 114 (02) :541-548
[89]   COMPUTED-TOMOGRAPHY FINDINGS IN DELIRIUM [J].
KOPONEN, H ;
HURRI, L ;
STENBACK, U ;
MATTILA, E ;
SOININEN, H ;
RIEKKINEN, PJ .
JOURNAL OF NERVOUS AND MENTAL DISEASE, 1989, 177 (04) :226-231
[90]   Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation [J].
Kress, JP ;
Pohlman, AS ;
O'Connor, MF ;
Hall, JB .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (20) :1471-1477